Medicare covers Cologuard under Part B if your doctor orders it and you meet specific conditions
Cologuard is a stool-based DNA test that screens for colorectal cancer and precancerous polyps. Medicare Part B covers the test when a doctor orders it for you, but only if you are between 50 and 85 years old, have no symptoms of colorectal disease, and have not had certain other screening tests recently. The test is covered once every three years if the results are normal.
You pay nothing out of pocket for the test itself when Medicare covers it — no copay, coinsurance, or deductible applies. Your doctor's office or a lab will handle the order and billing directly to Medicare. The key is that a doctor must order it; you cannot order Cologuard on your own and expect Medicare to pay.
Key Takeaways
- Medicare Part B covers Cologuard once every three years for people ages 50 to 85 with no colorectal symptoms.
- Your doctor must order the test — you cannot buy it yourself and submit it to Medicare for reimbursement.
- You pay nothing for the test when it is covered, but you are responsible for any follow-up procedures like colonoscopy if Cologuard finds something.
- If you have had a colonoscopy or sigmoidoscopy in the past 10 years, or a barium enema in the past 5 years, Medicare will not cover Cologuard until that screening window closes.
Who qualifies for Medicare coverage of Cologuard
You must meet all of these conditions for Medicare to cover Cologuard. You must be at least 50 years old and no older than 85. You must have no symptoms of colorectal disease — no blood in stool, no abdominal pain, no change in bowel habits, and no personal history of colorectal cancer or polyps. You must also have no family history of colorectal cancer, unless your doctor documents a medical reason to screen you anyway.
The timing of your other screening tests matters. If you have had a colonoscopy in the past 10 years, Medicare will not cover Cologuard until 10 years have passed since that colonoscopy. If you have had a sigmoidoscopy in the past 5 years, you must wait 5 years. If you have had a barium enema in the past 5 years, the same 5-year wait applies. These rules exist because Medicare considers these tests to be alternative screening methods, and it does not pay for overlapping screening in a short time frame.
How to get Cologuard through Medicare
Start by talking to your primary care doctor or gastroenterologist about colorectal cancer screening. Tell them you are interested in Cologuard. Your doctor will review your age, symptoms, and screening history to confirm you meet Medicare's conditions. If you do, your doctor will place an order with the lab that processes Cologuard (Exact Sciences).
Once your doctor orders the test, the lab will send you a kit by mail. You collect a stool sample at home, seal it in the container provided, and mail it back to the lab using the prepaid envelope. The lab processes the sample and sends results to your doctor, who will discuss them with you. The entire process takes about two to three weeks from the time you receive the kit.
What happens if Cologuard finds something
If Cologuard detects DNA changes that suggest cancer or polyps, your doctor will recommend a colonoscopy to look directly at your colon and remove any polyps found. Medicare covers colonoscopy as a diagnostic test when it follows an abnormal screening result, with no copay or deductible. You are responsible for any biopsies or polyp removal during the procedure, but these are typically covered at no cost when done as part of a diagnostic colonoscopy.
If Cologuard results are normal, you do not need any follow-up testing. You can have another Cologuard test in three years, or your doctor may recommend a different screening method depending on your age and risk factors at that time.
Cologuard versus other screening methods Medicare covers
Medicare covers several colorectal cancer screening options for people 50 and older. Colonoscopy is covered once every 10 years if results are normal, with no copay or deductible. Sigmoidoscopy is covered once every 5 years, also at no cost. Barium enema is covered once every 5 years. Cologuard is covered once every 3 years. Your doctor can help you decide which test fits your situation best — some people prefer Cologuard because it is non-invasive and done at home, while others prefer colonoscopy because it allows the doctor to remove polyps during the same visit.
If you have had one of these tests recently, you must wait until the coverage window closes before Medicare will pay for a different screening method. For example, if you had a colonoscopy two years ago, you cannot switch to Cologuard until 10 years have passed since that colonoscopy.
What to do if your doctor says you do not may have access to
If your doctor determines you do not meet Medicare's conditions for Cologuard coverage — for example, because you have symptoms of colorectal disease or a personal history of polyps — you have options. You can ask your doctor whether a diagnostic colonoscopy is appropriate instead, which Medicare may cover if there is a medical reason. You can also choose to buy Cologuard out of pocket; the test costs between $500 and $600 when you pay yourself, though some people receive discounts through the manufacturer's website.
If you believe your doctor made an error in determining you do not may have access to, you can request a second opinion from another doctor, or you can contact Medicare directly at 1-800-MEDICARE to ask about your specific situation. Medicare staff can review your medical history and screening records to confirm whether you meet the coverage rules.
Frequently Asked Questions
Does Medicare Part D or Medigap cover Cologuard?
No. Cologuard is covered only under Medicare Part B, which covers preventive screening tests. Part D covers prescription drugs, and Medigap covers cost-sharing like copays and deductibles — neither covers the test itself. If Part B covers your Cologuard, you have no copay or deductible to pay.
What if I am over 85 — can I still get Cologuard through Medicare?
Medicare's coverage rules state that Cologuard is covered only for people ages 50 to 85. If you are older than 85, Medicare will not cover it. You can discuss screening options with your doctor, who may recommend colonoscopy or other tests based on your health and life expectancy. You can also choose to pay for Cologuard out of pocket.
Can I order Cologuard online and have Medicare pay for it?
No. Medicare will only pay for Cologuard when a doctor orders it. If you order the test yourself online, Medicare will not reimburse you, even if you meet all other coverage conditions. You must see a doctor first and have them place the order with the lab.
How often can I get Cologuard through Medicare?
Medicare covers Cologuard once every three years if your previous result was normal. If you have had Cologuard before and it has been less than three years, Medicare will not cover another test. Your doctor can tell you when you become may be able to access for your next screening.
What if my Cologuard test is inconclusive?
If the lab cannot process your sample or the results are unclear, the lab will ask you to provide another sample. Medicare will cover the second test at no cost to you. Your doctor will work with the lab to arrange this, and you will receive another kit by mail.